Clinicians’ Practices In Pain Assessment And Management For Elderly With Heart Failure

Abstract

Introduction Although pain is not considered a hallmark heart failure (HF) symptom, 51% - 85% of patients with HF experience pain. Lack of accurate pain assessment can lead to ineffective pain management which may negatively impact HF management. Older adult patients (≥ 65 years old) with HF often under-report pain symptoms. Little is known about clinicians’ perspectives of pain assessment and the pain management that they provide to older adult patients with HF. Aim . To describe clinicians’ experiences of pain assessment and management in older adult patients with HF in an effort to improve the management of pain in this population. Methods This was a qualitative research study that employed in-depth interviews with clinicians who primarily take care of patients with HF across different states. Three coders reviewed transcripts using an approach and organized codes into themes from the pattern of descriptors. Results The median age of participants (N=20) was 42 years, 20% were male, and 90% were white. We identified 4 distinct themes: (1) general differences between elderly patients and younger adult patients while providing care; (2) strategies and challenges of pain assessment: (3) strategies and challenges of pain management; and (4) recommendations for improving pain assessment/management practice. Most participants noted that providing care to older patients was more complicated due to comorbid conditions such as high fall risk and kidney disease. Even though all participants assess pain briefly as a routine physical assessment, most stated that pain was not addressed as much as it should be. Participants also faced challenges with pain assessment in older patients who often express their experience of pain using descriptive words versus numbers on a pain scale. In terms of pain management, most recommended using analgesics for older adults, not so much using non-pharmacological interventions. Most participants were unaware of any educational materials or guidelines to manage pain or symptoms for patients with HF. A few participants suggested a higher integration between a HF clinic and pain specialists and developing non-pharmacological interventions such as routine physical therapy that could potentially be a helpful resource for pain management in this population. Conclusions Using consistent pain assessment for clinicians and integrating non-pharmacological pain management approaches into routine clinical care should be tested as methods for improving symptom control among older adult patients with HF. Although pain is not considered a hallmark heart failure (HF) symptom, 51% - 85% of patients with HF experience pain. Lack of accurate pain assessment can lead to ineffective pain management which may negatively impact HF management. Older adult patients (≥ 65 years old) with HF often under-report pain symptoms. Little is known about clinicians’ perspectives of pain assessment and the pain management that they provide to older adult patients with HF. . To describe clinicians’ experiences of pain assessment and management in older adult patients with HF in an effort to improve the management of pain in this population. This was a qualitative research study that employed in-depth interviews with clinicians who primarily take care of patients with HF across different states. Three coders reviewed transcripts using an approach and organized codes into themes from the pattern of descriptors. The median age of participants (N=20) was 42 years, 20% were male, and 90% were white. We identified 4 distinct themes: (1) general differences between elderly patients and younger adult patients while providing care; (2) strategies and challenges of pain assessment: (3) strategies and challenges of pain management; and (4) recommendations for improving pain assessment/management practice. Most participants noted that providing care to older patients was more complicated due to comorbid conditions such as high fall risk and kidney disease. Even though all participants assess pain briefly as a routine physical assessment, most stated that pain was not addressed as much as it should be. Participants also faced challenges with pain assessment in older patients who often express their experience of pain using descriptive words versus numbers on a pain scale. In terms of pain management, most recommended using analgesics for older adults, not so much using non-pharmacological interventions. Most participants were unaware of any educational materials or guidelines to manage pain or symptoms for patients with HF. A few participants suggested a higher integration between a HF clinic and pain specialists and developing non-pharmacological interventions such as routine physical therapy that could potentially be a helpful resource for pain management in this population. Using consistent pain assessment for clinicians and integrating non-pharmacological pain management approaches into routine clinical care should be tested as methods for improving symptom control among older adult patients with HF.